Individual
MARIE ELLEN CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D./O.
Contact information
Practice address
7 BLANCHARD CIR, WHEATON, IL 60189-2039
(630) 510-9009
(630) 510-0152
Mailing address
7 BLANCHARD CIR, WHEATON, IL 60189-2039
(630) 510-9009
(630) 510-0152
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036058883
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010044842
R/R MEDICARE
—
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036058883
—
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
Enumeration date
08/19/2006
Last updated
04/03/2013
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